Nepal Burden of Disease 2019: A Country Report based on the Global Burden of Disease 2019 Study

Overview

The Global Burden of Disease (GBD) study is a systematic effort to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors by age, sex, and geographies for specific points in time. The objective is to provide a comprehensive picture of total health loss due to diseases, injuries, and death to facilitate health sector planning and policy making. GBD considers 369 diseases and 87 risk factors in estimating burden of disease (BoD) and attribution of different risk factors. In 2019 GBD estimates, a total of 281,577sources were used including 402 data sources for Nepal.

Key results

Life expectancy and healthy life expectancy (HALE)

• Nepal’s life expectancy was 71.1 years in 2019. On an average, females (73.0 years) were found to live longer than males (69.2 years). Life expectancy increased by 12.7 years between 1990 to 2019. However, not all those additional years gained will be healthy ones.
• HALE, the average number of years a Nepalese citizen can expect to live in full health was 61.5 years, approximately 10 years lower than life expectancy. HALE of females (62.2 years) was slightly higher than that of males (60.9 years) in 2019. HALE increased by 11.1 years between 1990 to 2019.

Mortality

• A total of 193,331 deaths were estimated in Nepal for the year 2019, of which 71.1 % of deaths were due to NCDs, 21.1% of deaths were due to CMNN diseases and the remaining 7.8% of deaths were due to injuries.
• Cardiovascular diseases (CVDs) were the leading cause of death, with 24% of total deaths being attributable to CVDs.
• The proportion of deaths attributable to CVDs was 26.8% in males and 20.7% in females. Malignant neoplasm (cancer) was responsible for 11.1% of total deaths in both sexes, 10.8% of total deaths in males and 11.5% of total deaths in females.
• TB was responsible for 3.9% of total deaths in both sexes, 4.8% of total deaths in males and 2.8% of total deaths in females.

Disease burden

• DALY summarises the burden considering both early death and time spent with disability, DALYs provide an overview of a country’s overall population health. In 2019, 61.2% of total DALYs were due to NCDs, 29.3% were due to CMNN diseases and 9.6% were due to injuries.
• Cardiovascular diseases were the leading cause of DALYs in 2019. Approximately, 11.9% of total DALYs (both sexes), 14.3% of total DALYs in males and 9.4% of total DALYs in females were due to cardiovascular diseases.
• Cancer was responsible for 6.8% of total DALYs in both sexes, 6.7% of total DALYs in males and 6.8% of total DALYs in females.
• TB was responsible for 2.7% of total DALYs in both sexes, 3.5% in males and 1.9% (of total DALYs in females.

Risk factors

• In 2019, of the total deaths, 38.1% of deaths were due to behavioural risk factors, 31.2% were due to environmental/occupational risk factors and 22.9% of total deaths were due to metabolic risk factors.
• In 2019, 32.4% of total DALYs were due to behavioural risk factors, 21.7% were due to environmental/occupational risk factors and 13.5% were due to metabolic risk factors.
• In 2019, smoking was the most important risk factor and was responsible for 17.7% of total deaths and 8.5% of total DALYs.

Implications for policy and programme

• This report has used GBD 2019 results to illustrate the overall country BoD in terms of mortality and morbidity by major diseases and risk factors. The report has revealed an overall decline in the burden of CMNN diseases, but with an increasing burden due to NCDs between 1990 and 2019.
• Adaptation of health system to address rapid shift in disease burden.
• Addressing health beyond health sector
• Sustaining progress on CMNN diseases
• Transitioning to a sustainable financing mechanism and self-sufficient health system
• Supporting evidence informed decision making at provincial and local levels
• Addressing additional data need for more precise estimates

Conclusions

This report extracted and summarised data from the 2019 GBD Study to present Nepal’s health status in terms of overall mortality, causes of mortality, causes of morbidity and risk factors.
The NBoD 2019 revealed increasing life expectancy and HALE from 1990 to 2019. The study findings suggest a changing nature of the burden of disease with NCDs being a more common cause of death, YLLs, YLDs, and DALYs in 2019 compared to 1990. In the same period the number of deaths, YLLs, YLDs and DALYs for most of CMNN diseases has decreased notably.
Despite a notable decline in the burden of CMNN diseases, they are still among the leading causes of mortality and morbidity. The health system needs to carefully consider resource allocation so that the health system is equipped to deal with the increasing burden of NCDs while ensuring that CMNN diseases are not under resourced.

Prioritisation of modifiable risk factors could reduce avoidable mortality in the coming days. The findings of this study are confined to uncovering the health priorities at the national level.